Understanding Grief, Loss, and Ethical Considerations in Psychological Practice

Rev. Dr. Richard S. Sinacola Licensed Psychologist Pastor: St. Giles Catholic Community Palm Springs, CA

Dr. Lester Havens Dr. Robert Carkhuff Pre Phase I Phase II Phase III Attending Responding Personalizing Initiating Involving Exploring Understanding Action

Ethical considerations: Dual or multiple relationships Any relationship outside of your role as priest, pastor, or chaplain. Self-disclosure: Follow the Sinacola Brief Model: B: Keep it brief R: Is it related? I: Is it insensitive, too intense or intrusive? E: Only share with empathy F: Ask for feedback.

Getting ready for the first session: 1. Welcome and eliminate distractions. 2. Offer water or a hot beverage (avoid food). 3. Make sure the lighting is soft and indirect. 4. Make sure the chairs are of equal comfort and height. 5. Place client s chair at 15-20 degree angle, but your chair in direct sight. 6. Remove offensive or controversial art work or personal pictures. 7. Begin by asking how you can help, avoid using the word why.

Defining grief and loss: Webster s dictionary: Intense emotional suffering caused by loss or a disaster, and accompanied by deep sorrow and sadness. Dr. Linda Schupp: Normal, complicated, or traumatic grief. J. William Worden: Task I: Accept Task II: Work through the pain. Task III: Adjust to a new world without the person. Task IV: To emotionally relocate them and move on. I add task V: Reinvent your life around your needs. Others you have observed?

Dr. Linda Schupp: Complicated grief: Something is interfering with grief: Care giving, mental illness, financial instability. Grieving that goes on for months or years without improvement is by definition complicated. Up to 30% of all cases are complicated. Symptoms may include intense anger, substance abuse, social isolation, and bizarre psychological reactions. Often seen when one has to grieve over time while caring for the person, those who lost a child, or those who could not say good-bye because of a sudden death.

Traumatic grief: Being considered in the DSM-5. These grievers are especially attached to the one who died. This does not apply to loss of a friend, relative, or job. (See movie: Supernova). These folks are more prone to suicidal behaviors. Dr. Kubler-Ross: Denial, Anger, Bargaining, Depression and Acceptance. Consider the sixth stage of meaning proposed by Dr. David Kessler.

Retirement and aging: Dr. Sinacola: Lamenting the Loss. Women and menopause. The loss of health for those with chronic illness or chronic pain. Other losses? Pastoral counseling vs. psychotherapy: Pastoral to address the spiritual issues Psychotherapy addresses psychological issues. Dr. Brenner: Pastoral addresses the spirit and faith within a person, and psychotherapy the pathology within a person.

Most States do not require clergy to be licensed and therefore they may provide counseling services only to their congregants without a licensed. It is assumed they are only providing pastoral or spiritual direction and do so without a fee. Making a referral for services: Master s level: MSW, MFT, MA counselors and NP. Doctoral Level psychologists: Psy.D., Ed. D or Ph.D. Psychiatrists: MD or DO with residency in psychiatry. Note: All of these professionals should be licensed, and should be members of their appropriate professional association. Should clergy be licensed?

When providing pastoral counseling for grief and loss remember: A. There is no one right way, but there are wrong ways! B. Keep it brief (4-6 sessions) to avoiding a dependency relationship. C. Refer all mental health issues as you are not here to cure their grief or personality issues. Would you recognize a severe mental illness? D. Stay focused, active, and directive. E. Don t try to answer the unanswerable philosophical or theological questions. Instead just listen a lot!

Beginning the session and setting the pace: Assess where they are and what their needs may be. Things to say and avoid. James and Friedman: Six things to avoid saying: Don t feel bad. Replace the loss. Grieve alone Just give it time. Be strong for others. Keep busy and you won t think of them.

Structuring the counseling experience: 4-6 sessions. 1. In the first one hour session, just listen and have them tell you about their loss and introduce the person they lost to you. At the end, finish the session with a prayer or a comforting scripture or poetry based on their level of faith or belief. Be sure to have a box of tissues! Ask for feedback on the session. At the end of this session assess them for depression or sleep disturbance and make a referral if needed (explore sleep issues and medications). 2. Have them create a grieving space rather than having the entire house be a place of grieving.

3. In the second session I ask the client to create a time-line of their life with the deceased and bring it to the next session. Some counselors have clients write grieving letters to the deceased. This can be one per week for several weeks or seven letters in seven days. Here they can express sadness, anger, or even ask questions. They are also given a reading list of helpful books to begin to read. 4. In the third session they share the time-line and perhaps something from the reading they found helpful. I then ask them to begin to share their letters to the deceased with me. I ask them to consider ways that they can reinvent themselves.

5. In the fourth session we review their ideas and listen to more of the letters and notes from their reading. We discuss the stages of loss and the need to find meaning and to reinvent oneself. 6. In the fifth session we review their ideas for change and listen to their concerns about guilt and loneliness. We discuss the stages of loss and the need to reinvent oneself and accept change. Talk about discarding items of the deceased slowly and with thought. No rush here as this is an ongoing project. 7. Schedule a follow-up session in one to two months.

Dr. Martin Seligman: Dealing with the three Ps. Personalization: the belief that we are at fault. Pervasiveness: That this will affect all areas of your life. Permanence::The belief that this will affect our lives forever. The role of prayer and religion Loss and Anger at God: Richard Leonard, S. J. : God is the bringer of life, not death. The Old Testament vs. New Testament God. Other sources of loss: Illness, career, children, pets, purpose and even dating.

Students will present their findings on helpful scripture and perhaps not so helpful! What can we use other than Mt 5, 11, and 25; John 6, 12 and 14, or Wis 3:1-9? Yes or no on Psalm 23? Students will present their mini-lectures on their research findings. Final thoughts on the course and an open sharing of helpful techniques when working with loss.

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